David Keohane1, David Morrissey2. 1. Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland. doctorkeohane@gmail.com. 2. Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland.
Abstract
BACKGROUND: Posterior sternoclavicular dislocations are common in younger patients and are frequently due to high energy sporting incidents. AIM: We aim to demonstrate a novel technique that is safe and aims to provide good functional post-operative outcomes for patients with this injury. METHODS: This was a single-surgeon case series of four young patients from October 2017 to July 2019. The operative technique involved relocating the joint and holding it in situ with nylon suture tape. The tape was anchored in holes drilled in the sternum and passed through tunnels drilled into the medial clavicle. All of the patients were contacted retrospectively and a Nottingham Clavicle Score (NCS) was performed for each patient on a post-operative basis. RESULTS: No intra-operative or post-operative complications were noted. All of the patients demonstrated a significant improvement in their functional outcomes after the operation. The average NCS for the four patients was 82/100. DISCUSSION: There are a variety of techniques described in the literature to repair this ligament using either plates or tendon grafts. All of these techniques describe the drilling of anteroposterior holes in the manubrium and clavicle which run the intra-operative risk of perforating a major vessel. This paper is the first one to describe a technique which uses superior inferior holes which minimizes the risks, making the procedure safer for the patient. CONCLUSIONS: We believe this novel technique is safer than the existing described techniques, and it does not compromise on functional outcomes.
BACKGROUND: Posterior sternoclavicular dislocations are common in younger patients and are frequently due to high energy sporting incidents. AIM: We aim to demonstrate a novel technique that is safe and aims to provide good functional post-operative outcomes for patients with this injury. METHODS: This was a single-surgeon case series of four young patients from October 2017 to July 2019. The operative technique involved relocating the joint and holding it in situ with nylon suture tape. The tape was anchored in holes drilled in the sternum and passed through tunnels drilled into the medial clavicle. All of the patients were contacted retrospectively and a Nottingham Clavicle Score (NCS) was performed for each patient on a post-operative basis. RESULTS: No intra-operative or post-operative complications were noted. All of the patients demonstrated a significant improvement in their functional outcomes after the operation. The average NCS for the four patients was 82/100. DISCUSSION: There are a variety of techniques described in the literature to repair this ligament using either plates or tendon grafts. All of these techniques describe the drilling of anteroposterior holes in the manubrium and clavicle which run the intra-operative risk of perforating a major vessel. This paper is the first one to describe a technique which uses superior inferior holes which minimizes the risks, making the procedure safer for the patient. CONCLUSIONS: We believe this novel technique is safer than the existing described techniques, and it does not compromise on functional outcomes.
Authors: Donald S Bae; Mininder S Kocher; Peter M Waters; Lyle M Micheli; Michael Griffey; Laura Dichtel Journal: J Pediatr Orthop Date: 2006 Jan-Feb Impact factor: 2.324